From the Guidelines
The renal lesion seen in preeclampsia is glomeruloendotheliosis, which is characterized by enlargement of the glomerulus caused by hypertrophy of endothelial cells.
Key Features of Glomeruloendotheliosis
- Enlargement of the glomerulus
- Hypertrophy of endothelial cells
- This lesion is unique to preeclampsia and is not seen in other forms of hypertension 1
Pathophysiology of Preeclampsia
- Preeclampsia is a multisystemic syndrome characterized by endothelial dysfunction, inflammation, and metabolic dysfunction 1
- The exact cause of preeclampsia is still unclear, but it is thought to involve abnormal placentation, placental insufficiency, and an imbalance of antiangiogenic and proangiogenic factors 1
- The renal lesion of glomeruloendotheliosis is thought to be a result of the endothelial dysfunction and inflammation seen in preeclampsia 1
Clinical Significance
- Glomeruloendotheliosis is a key feature of preeclampsia and can be used to diagnose the condition 1
- Understanding the pathophysiology of preeclampsia and the renal lesion of glomeruloendotheliosis can help guide treatment and management of the condition 1
From the Research
Renal Lesions in Preeclampsia
The renal lesions seen in preeclampsia are characterized by:
- Glomerular capillary endotheliosis, which is a specific variant of thrombotic microangiopathy 2
- Hypertrophy of the intracapillary cells, including endothelial and mesangial cells, with marked enlargement and vacuolization of lysosomes 3
- Subendothelial and mesangial electron-dense deposits, as well as interposition of mesangial cell cytoplasm or mesangial matrix along an otherwise normal basement membrane 3
- Disruption of the symbiosis between glomerular endothelium and podocytes, leading to proteinuria and renal lesion 4
Pathogenesis of Renal Lesions
The pathogenesis of renal lesions in preeclampsia is thought to be mediated by:
- An imbalance in angiogenic factors, leading to systemic endothelial dysfunction 5
- A soluble vascular endothelial growth factor receptor that deprives glomerular endothelial cells of vascular endothelial growth factor, leading to cellular injury and disruption of the filtration apparatus 2
- Alterations in the expression of vascular endothelial growth factor (VEGF) by podocytes, resulting in a dramatic endothelial phenotype 4
Reversibility of Renal Lesions
The renal lesions seen in preeclampsia are thought to be fully reversible, with no remote cardiorenal effects on patients 3